The relationship between the intracanular concentrations of unbound (free) furosemide and its natriuretic effect is in the form of a sigmoid curve with a minimum effective furosemide excretion rate of about 10 g / min. Therefore, prolonged infusion of furosemide is more http://canadaslim.net/buy-lasix/ effective than repeated bolus administration. In addition, if a certain bolus dose is exceeded, no significant increase in the effect is observed. When the tubular secretion of furosemide decreases or when the drug binds to the albumin located in the lumen of the tubules (for example, in a nephrotic syndrome), the effect of furosemide decreases.

Module 3: Talking about suicide Risk: How you ask makes a difference

Talking with Potentially At-Risk Faith Members

No Two Situations Are Alike

Talking about suicide and suicide risk can be challenging and uncomfortable. People are complicated, no two situations present the same way, every individual is unique, and every relationship between a faith leader and the individuals for whom they provide care is different and special. Because of this, there is unfortunately no simple lockstep procedure to follow for each and every situation.

Clinical Judgment

Clinical judgment is similar to your ability to discern and address spiritual issues: your spiritual discernment. When healthcare providers are confronted with a challenging and complex set of symptoms, clinical judgment is knowing when to emphasize, explore, and respond to different areas. Since the causes of suicidal behavior and suicidal behavior itself are complex, there are no “cookie cutter” formulas for dealing with individuals potentially at-risk for suicide. As a result, you must learn to hone your own clinical judgment in deciding what to ask about and how to ask about it, and then what to do next. This comes with experience.

Information Driven, Not Protocol Directed.

Rather than think of talking about suicide as guided by a simple protocol or procedure, it is more helpful to think of it as a guided by a set of information that you want to gather. Your goal in discussing suicide risk with a faith member is to understand whether and to what extent that person is indeed at risk. To do that you need to determine the presence of suicidal ideation, warning signs, risk factors, and triggering events. Along the way, you will also be looking for the presence of, and opportunities to reinforce, protective factors.

Conversations about suicide are in many ways like discussions about an individuals spirituality or connection to God: a very idiosyncratic dialogue that can not be standardized into a one-size fits-all approach.

Making Thoughts and Feelings Observable

Because thoughts and emotions aren’t usually observable, we have to ask. Sometimes we may see overt warning signs, we may perceive some risk factors, or learn about trigger events in a person’s life. Friends and family members may even directly express concerns. However, the best way to find out if someone is at risk is to do what you already do very well with your faith members: talk to them!

Specifically, because thinking and feeling aren’t observable, we have try to make them observable, in the sense of getting people to talk about them. In the case of thinking about suicide—that is, suicidal ideation—this may be uncomfortable and sensitive for both you and the people about whom you are concerned.

Remember, raising the subject of suicide and asking directly about suicidal thinking do not increase the risk of suicide in someone already experiencing suicidal ideation. They also do not cause suicidal thoughts in those who are not already experiencing them.

Not asking specifically about suicide does increase the likelihood that someone who needs help will not be identified.

How you raise the issue and what you ask about—and how you ask questions and respond to answers—can be extremely important. They can be the difference between an open, trusting, productive discussion and an unproductive, stilted failure.

Suicide-related Dialogue: Natural Structure and Flow

Although there is no cookie cutter approach, there is a general structure, a natural order of sorts, to how you engage in a dialogue with someone about whom you are concerned.

Although not all situations will map to this flow, most discussions with people you are concerned about will, just as most conversations in general follow this loose structure of establishing rapport, circling into the heart of a conversation, and disengaging.

From opening the door, establishing rapport, and easing into the topic, to handling responses and disengaging: this module will address these stages of engaging in discussion of suicide risk. Specific steps and strategies for taking steps to ensure safety when risk is identified will be discussed in their own module later in this course.

If you are experiencing strong feelings or thoughts about suicide, call 1-800-273-TALK to speak with a trained counselor in a certified crisis center in your area. The call is free and available 24-hours a day.